Primary spinal paragangliomas: a clinicopathological and immunohistochemical study of 30 cases

Aims: Extra-adrenal paragliomas are neoplasms which have been the subject of much debate regarding parameters to establish their biological behaviour. This study describes the clinicopathological and immunohistochemical features of 30 cases of spinal paragliomas. Methods and results: There were 15 male and 15 female patients. The median age at diagnosis was 46 years (range 20–74 years). Fourteen patients presented with back pain, two with numbness of the lower extremities, one with difficulty in walking and one with spinal cord compression. Nineteen tumours were located in the lumbar region, six in the cauda equina, two in the filum terminale, two in the thoracic region and one in the cervical region. All patients underwent gross total excision. The size of the tumours ranged from 10 to 50 mm. Histologically, 18 neoplasms showed alveolar (Zellballen) pattern, seven a spindle component, two eosinophilic granular cells suggestive of oncocytic metaplasia, two melanin pigment and one ganglion cells. Positive immunohistochemical results include: neuron-specific enolase 23/23 (100%), synaptophysin 21/23 (91%), S100 protein 22/23 (95%, sustentacular cells), leu-enkephalin 11/23 (47%), somatostatin 8/23 (34%), focal glial fibrillary acidic protein 7/23 (30%), focal keratin 5/23 (21%), neurofilament proteins 3/23 (13%) and adrenocorticotrophic hormine (ACTH) 1/23 (4%). Follow-up information obtained in 20 patients show 17 patients alive over a period of 6–216 months. One patient had bone metastases. Two patients died of unrelated causes, including one of congestive heart failure and one of myocardial infarction. Conclusions: In our experience, spinal paragangliomas behave as slow-growing tumours susceptible to potential cure by total excision. We agree with the current World Health Organization (WHO) classification as grade I tumours. Less than 1% may be locally aggressive. Spinal paragangliomas immunoreact not only for conventional neuroendocrine markers but also for peptides including somatostatin and ACTH and focally for the epithelial marker keratin.     

In Vivo Treatment of Rats with Monoclonal Anti-T-Cell Antibodies

The effects of intraperitoneal injection of monoclonal anti-rat T-lymphocyte antibodies were evaluated immunohistochemically and functionally in normal rats and in rats with experimental allergic neuritis. In the normal animals a single injection of OX8 antibodies, reactive with suppressor/cytotoxic T cells, completely eliminated OX8-reactive cells from peripheral lymphoid organs and from circulation, whereas the 'pan' T-cell-reactive W3/13 antibodies and the helper T-cell-reactive W3/25 antibodies only caused a partial elimination of their respective target cells. Injection of the W3/13 and W3/25 antibodies but not of OX8 antibodies led to a diminished responsiveness to allogeneic stimulation in vitro for spleen cells obtained from the treated rats, whereas the OX8 injection caused a complete elimination of the in vitro cytotoxic response to allogeneic cells in the mixed lymphocyte reaction-activated spleen cell population. When Lewis rats were injected with peripheral nerve myelin and Freund's adjuvant for the induction of EAN, treatment with W3/13 antibodies completely prevented the onset of disease, whereas treatment with the OX8 antibodies exaggerated the disease symptoms.     

A REVIEW OF LEISKE STYLE SEMI-FLEXIBLE INTRAOCULAR LENSES 1981–1984

A consecutive series of 205 patients had 237 intracapsular cataract extractions performed with the insertion of a semi-flexible intraocular lens in the period 1981–1983. The average follow-up period was 17.8 months; 87.0% of cases obtained a visual acuity of 6/12 or better after operation, compared with 80.6% of cases whose preoperative visual acuity was 6/36 or worse. Twenty-six eyes (11 %) had clinical cystoid macular oedema at some stage after operation, and seven eyes (3%) had persistent cystoid macular oedema at final follow-up. Only one eye had a postoperative retinal detachment. Thirty eyes (14.1%) required treatment for elevated intraocular pressure at some time after operation.     

A Developmental Neurotoxicity Evaluation of the Effects of Prenatal Exposure to Fluoxetine in Rats

Fluoxetine is a widely used serotonin reuptake inhibitor effectivein the treatment of depression. This experiment assessed thepotential developmental neurotoxicity of fluoxetine. Sprague-DawleyCD rats were treated once per day on Days 7–20 of gestationwith 0, 1, 5, or 12 mg/kg of fluoxetine (free base) dissolvedin distilled water. One control group received water by gavage;animals in this group were provided food and water ad libitum.The second control group (PF) also received water by gavage;animals in this group had their food and water restricted bypair-feeding and watering them to the 12 mg/kg fluoxetine group.Litters were culled to 12 after birth and offspring (male/femalepairs) were tested neurobehaviorally at three developmentalstages (preweaning, juvenile, and adult). At each stage, twopairs per litter received tests of locomotor activity, acousticstartle, and startle after administration of one of two pharmacologicalchallenges (one pair each receiving fluoxetine or apomorphine).Two pairs were also tested for spontaneous alternation, passiveavoidance, and complex learning in a water maze. At the highestdose, fluoxetine caused maternal weight loss during pregnancy,reduced litter sizes at birth, and increased neonatal mortality.No effects on long-term growth or survival were seen. Prenatalfluoxetine exposure produced no significant effects on locomotoractivity, spontaneous alternation, passive avoidance, or watermaze performance. A few scattered interactions involving treatmentgroup were obtained on startle, but no pattern of treatment-relatedchanges was evident. Regional wet and dry brain weights takenat each stage were not affected by prenatal fluoxetine exposure.The data suggest that fluoxetine is not developmentally neurotoxicin the rat.     

Lung Scanning for Pulmonary Embolism: Clinical and Pulmonary Angiographic Correlations

A group of 78 patients with suspected pulmonary embolism wasstudied by both ventilation perfusion lung scanning and pulmonaryangiography. Symptoms and clinical signs were analysed usingBayesian techniques to produce pre-test odds for pulmonary embolismin individual patients. While, as a group, those with embolismcould be discriminated from those without on this basis, majoroverlap existed between the groups, invalidating the use ofthis approach for individual patients. Strict diagnostic criteria for interpretation of lung scanswere accurated using pulmonary angiography as the ‘goldstandard’, but at the expense of a significant numberof patients (38 per cent) in the indeterminate (non-diagnostic)group. In the 48 patients in whom the test yielded a diagnosticresult, there was a sensitivity of 100 per cent (15/15) anda specificity of 97 per cent (32/33). In the series as a whole,the likelihood of lung scanning correctly diagnosing pulmonaryembolism was 55 per cent (15/27) and of correctly excludingembolism, 63 per cent (32/51). By the use of strict criteria for interpretation of lung scanning,reliable information can be obtained on the presence of absenceof pulmonary embolism in a large proportion of patients suspectedof having the condition. Such information is more discriminatingthan clinical signs and symptoms.     

Digoxin-specific Fab fragments impair renal function in the rat

Abstract— The effect on renal function, and the plasma and urinary disposition, of digoxin-specific antibody fragments (DSFab), were studied using the rat as an experimental model. After 24 h, DSFab (2 mg kg^?11, i.v.) caused decreases in urine volume and creatinine clearance of 34 and 33%, respectively, when measured in the same rats. However, only the creatinine clearance was significantly changed when compared with a separate saline-treated control group. Plasma and urinary creatinine concentrations were unaffected by DSFab treatment. Since creatinine clearance approximates to glomerular filtration rate (GFR), it appears that a dose of DSFab equivalent to about one-fifth of the usual clinical dose, causes a reduction in GFR of about one-third. In patients undergoing digitalis therapy, a degree of renal impairment is common and it is possible that this may be exacerbated by treatment with DSFab. DSFab had an elimination half-life of 178 min, an apparent volume of distribution (Vd) of 106 mL kg^?1 and a plasma clearance of 0·42 mL kg^?1 min^?1. If it is assumed that the plasma volume of a rat is approximately 35 mL kg^?1, the measured Vd suggests appreciable penetration of DSFab into the extracellular fluid at this dose. Seventy-two hours after injection, only 7·6% of the administered dose of DSFab was found in the urine.